title: Can we increase the chance of sphincter saving surgery in rectal cancer with neoadjuvant treatments: lessons from a systematic review of recent randomized trials.
abstract: OBJECTIVE
  A common hypothesis is that neo-adjuvant treatment in rectal cancer, is able to increase sphincter saving surgery. This review studies data relevant to this question.
  
  
  METHODS
  A total of 17 randomized trials were analysed.
  
  
  RESULTS
  Since 1976, the rate of sphincter saving surgery increased from 20% to 75%. In none of the 17 trials it was possible to demonstrate a significant benefit of the neo-adjuvant regimens on the rate of sphincter saving surgery. There was a reduction in the risk of 5-year local recurrence partly due to these neo-adjuvant treatments. These neo-adjuvant regimens had no significant impact on the overall 5-year survival.
  
  
  CONCLUSIONS
  None of the neo-adjuvant treatments tested was able to demonstrate an increase in the rate of sphincter saving surgery. The improvement in conservative surgery is mainly due to technical changes in surgery. Organ preservation after complete clinical response appears as an interesting hypothesis to test.
authors.affiliation: Department of Radiotherapy, Centre Antoine Lacassagne, Nice, UNSA, France. jean-pierre.gerard@nicr.fnclcc.fr
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gerard
authors.forename: Yousri
authors.initials: Y
authors.lastname: Rostom
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Gal
authors.forename: Daniel
authors.initials: D
authors.lastname: Benchimol
authors.forename: Cécile
authors.initials: C
authors.lastname: Ortholan
authors.forename: Carlo
authors.initials: C
authors.lastname: Aschele
authors.forename: Jean-Michel Hannoun
authors.initials: JM
authors.lastname: Levi
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D006801:Humans; D020360:Neoadjuvant Therapy; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000601:surgery / Q000628:therapy*